Provider Demographics
NPI:1114927282
Name:LOWELL ANESTHESIOLOGY SERVICE, INC.
Entity Type:Organization
Organization Name:LOWELL ANESTHESIOLOGY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORAIRATU
Authorized Official - Middle Name:
Authorized Official - Last Name:THAVASEELAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-689-4601
Mailing Address - Street 1:60 EAST ST
Mailing Address - Street 2:STE 1400
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4500
Mailing Address - Country:US
Mailing Address - Phone:978-689-4601
Mailing Address - Fax:978-689-3096
Practice Address - Street 1:60 EAST ST
Practice Address - Street 2:STE 1400
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4500
Practice Address - Country:US
Practice Address - Phone:978-689-4601
Practice Address - Fax:978-689-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
600165OtherTUFT
MAM11362OtherBCBS
CA3406OtherRR MEDICARE
NH30004048Medicaid
MA9703462Medicaid
MAM11362OtherBCBS